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Potential repercussions of the Sept. 11 terrorist attacks on New Yorks World Trade Center and the Pentagon are many and varied.

Madeleine Estabrook, partner in the Boston headquarters of national law firm Edwards & Angell, feels a national epidemic of post-traumatic stress syndrome cannot be ruled out as one of them; and, she suspects the managed care industry is not up to the task of handling such a possibility, mainly because of a nationwide dearth of mental health-care practitioners.

“How are we going to service the population, how are we going to make sure theres sufficient access for everyone who may need services now or later or for a significant period of time,” Estabrook says.

“Most communities respond with clergy, schools, community support, but true mental health services need to be received from the medical community which may not have the resources.”

Estabrook, whose concentration is in health-care law, says that although she is not in a position to say definitively that the nation is in the midst of an epidemic, the Senate has heard testimony by university professors of psychiatry and mental health-care professionals suggesting that such an outcome can be expected, based on the aftermath of the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City.

A Sept. 18 press release from ComPsych Corporation, a Chicago-based provider of behavioral health and work-life services, lends support to Estabrooks theory of a substantially increased need for mental health services. According to the release, the company experienced a 1000% spike after the attack.

“We anticipate these numbers to grow as the reality of the situation continues to set in,” says Dr. Richard Chaifetz, CEO of ComPsych. “The ramifications of this event will change our countrys workforce forever.”

But Dr. Jonathan Book, executive vice president and chief medical officer for Magellan Behavioral Health, whose parent company is Magellan Health Services Inc., Columbia, Md., one of the nations largest providers of managed behavioral health services, does not foresee an increased demand for mental health-care treatment great enough to overburden the system.

“In terms of the magnitude of this tragedy this is an unprecedented event, so we cant predict what to expect based on our experiences with local events alone,” Book says. “We are not seeing a national epidemic.”

He says the country is responding nationally in a number of ways, ranging from anxiety and depression, for which most people dont seek professional help, to more severe, pathological reactions, including post-traumatic stress syndrome.

Because reactions occur in phases, it is unlikely an epidemic would be evident in the immediate future anyway, he says.

The first stage is the need for stress management. Subsequent to that is grief and anxiety, “the shaking of security that all of us feel after this attack, and then down the pike, which has yet to emerge, is the question of which of the anxieties and grief will turn into pathological reaction,” Book says.

There has been an increase in requests for mental health services in the vicinities of the attacks, Book says, particularly in the New York area, but such has not been the case elsewhere in the country.

Book adds that it is impossible to know whether the people currently seeking help would have done so anyway, or they were especially vulnerable to a catastrophic event.

Whether there will be a shortage of mental health practitioners available if an epidemic were to occur, Book says is impossible to predict.

Based on the response by the managed care providers in Magellans network, Book doesnt doubt the networks ability to mobilize in a timely manner and handle a sudden increase in need.

“Were particularly proud of our network provider community,” he says. “They were anxious to make sure we knew they were available, to extend hours and go above and beyond their duties to help.

“We think based on how weve handled the immediate attack were in good shape.”

Saul Feldman, chairman and CEO of United Behavioral Health, a San Francisco-based managed care company for mental health, says a large number of people can be defined as having post-traumatic stress syndrome as a consequence of the attacks; however, he feels labeling the current situation an epidemic is overstating the case.

“Theres a significant number of depressed people, thats to be expected, but rather than being chronic, its situational,” Feldman says. This happens as a consequence of a “specific event in ones life and generally speaking it passes and life goes back to normal.”

Feldman says that literature on post-traumatic stress syndrome indicates that about 75% of those suffering from it get better by themselves in a few weeks; the other 25% do not.

“But its difficult to know what percentage of those people would have needed help anyway, or whether their condition was exacerbated by what took place,” he says.

Feldman says the demand for help increased by about 25% in the days following Sept. 11 and that trend has continued to a degree, but the need has not overwhelmed Uniteds network.

With a 40,000-strong, national network of clinicians, the people who need help have been able to get it, he says.

“Whats not clear is what the reaction of the general public will be if acts of terrorism continue, because this event is really quite different from events we have experience with.”

Reproduced from National Underwriter Life & Health/Financial Services Edition, October 29, 2001. Copyright 2001 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.

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